fitting back in

The NG tube issue was addressed today, to such effect that the nurses started calling me to inform me that they had neglected to note the ins-and-outs for two hours. Which is of course what I ought to expect for making a nuisance of myself; but I’d honestly rather that they pay over-meticulous attention to the matter, than to ignore it entirely. I would rather be known as “that nasty surgeon who obsesseses about ins-and-outs” than have my surgical patients as neglected as they have been.

Our chief this month is a great teacher. He doesn’t make a big splash, being much less flamboyant than many surgical chief residents I’ve known; but he will quote you the numbers on almost any question you ask, and break down the ten different histological subtypes of any cancer, with their differing prognoses. Sometimes people are annoyed with how meticulous and painstaking he is, but I’ve found by experience that whenever I’m about to try ignoring one of his directives, on the grounds that it’s simply too particular, its value will promptly be proven by catching or preventing a problem with a patient. Today he was teaching one of the medical students how to sew. It was the end of the day, the end of a long case, and I’m not sure I would have even tried to let the student sew. The chief not only handed him the needle-driver, but spent twenty minutes instructing him in precisely the right way to place the stitches. I was amazed by his patience. It paid off, too, because the second half of the incision was one of the neatest closures I’ve ever seen a student make. I need to be more careful with my students.

It’s both rewarding and annoying, after a month on nights, where no patients truly belong to you, and random patients keep popping up with problems, to rediscover the ownership of an individual service, being once again completely responsible for a finite group of people. I’m also discovering what fun it is to be simply consulted on patients who have been admitted to hospitalists. I admit that I can see why the rest of the surgeons like this arrangement so much – almost no work to do except operate. It still feels like cheating to me – dancing without paying the fiddler – but it is smooth.